Between Love and Devaluation: Etiology, Clinical Picture, Social Impact, Diagnosis and Treatment of Narcissistic and Borderline Personality Disorders

Resumo

Introduction: Narcissistic personality disorder (NPD) and borderline personality disorder (BPD) represent complex conditions marked by patterns of emotional dysregulation, interpersonal conflicts, and distorted self-perception. While NPD is characterized by grandiosity, need for admiration, and lack of empathy, BPD involves affective instability, impulsivity, and fear of abandonment. Both emerge from interactions between biopsychosocial factors, such as genetic predispositions, early trauma, and dysfunctional family dynamics, generating significant impacts on social relationships and public health. The dichotomy between the search for love and patterns of devaluation is reflected in the clinical setting, where patients oscillate between idealization and contempt, complicating diagnoses and interventions. In addition, the social stigma associated with these disorders often limits access to appropriate treatments. Objective: The purpose of this systematic literature review was to analyze the scientific production of the last ten years on the etiology, clinical manifestations, social repercussions, diagnostic methods and therapeutic approaches of narcissistic and borderline personality disorders, aiming to integrate evidence that helps in the multidimensional understanding of these conditions. Methodology: Using the PRISMA checklist, searches were conducted in the PubMed, SciELO and Web of Science databases, with the descriptors: "narcissistic personality disorder", "borderline personality disorder", "etiology", "social impact" and "psychotherapy". Original articles published in the last decade, in English or Portuguese, that addressed clinical or social aspects of the disorders were included. Case studies, non-systematic reviews and articles not directly related to the descriptors were excluded. The screening involved reading titles, abstracts and full texts, ensuring the selection of 45 relevant studies. Results: Fifteen studies were selected, highlighting the multifactorial etiology, with emphasis on childhood abuse for BPD and parental overvaluation for NPD. The clinical picture of BPD included self-mutilation and depressive comorbidities, while NPD was associated with manipulation and fragile self-esteem. The social impact revealed stigmatization, work difficulties and isolation. Dialectical-behavioral and mentalization-based therapies showed efficacy in BPD, while NPD showed lower therapeutic adherence. Accurate diagnoses require longitudinal assessment, due to symptomatic overlap with other disorders. Conclusion: The synthesis highlighted the need for integrative approaches, combining psychosocial and pharmacological interventions, in addition to public policies to reduce stigma. The diagnostic and therapeutic complexity reinforces the importance of professional training and family support. Future studies should explore personalized strategies, considering the cultural and socioeconomic nuances that influence the course of these disorders.